Deja vu all over again...this is a mirror of the discussion of the value of ERP systems in the 1990's, the Internet in the early 2000's and others too numerous to mention. Early in the adoption lifecycle there are always naysayers who latch onto any negative data to make their point that the change is a bad thing. Take the HHS letter to the hospitals about upcoding which sounds political to its core.

Does an electronic system allow for upcoding? Sure. No more nor less than the old systems ever did...but committing it to an EMR can improve compliance and the ability to investigate fraudulent behavior such as upcoding. Is an equally plausible explanation be that the accurate capture of encounter data allows for the [more] accurate coding for billing purposes and that this accuracy could contribute to increased charges? Sure it could. The problem is nobody has reduced this debate to fact...so the politics continue.

Having spent significant time in my past at Kaiser Permanente helping to implement their EMR, there are a lot of good reasons for doing so. Capturing clinical data so that it is computable (which it emphatically is not in a paper chart!) is extraordinarily valuable...and takes time and new, innovative efforts to capitalize upon. Achieving integration among the dog's breakfast of legacy clinicial systems is equally time consuming but the aggregation of the data into usable information can (and in some places, does) have a measurable impact on performance (both cost and clinical quality).

How many of the health systems implemented EMRs because they wanted the HHS money or because the were "compelled to" by the APA/HITECH provisions? That is no reason to undertake such a large ORGANIZATIONAL CHANGE initiative (it isn't an IT project!). Those organizations that invested in EMRs for all the right reasons - Kaiser, Group Health, Intermountain, UPMC, and others - are getting their benefits and are not looking back. Others, not so much...

I will close with a thought and a quote. The thought is that if you understand that the EMR is a foundational investment required to deliver the value of population health, patient-centered care, and other interesting delivery models that are impossible without access to computable healthcare information, you have the ability to manage the changes that it will require in your health system to deliver the benefits that the lucky few have achieved. The quote is from Churchill: "This is not the end; it is not even the beginning of the end. It is, perhaps, the end of the beginning..."

I think it would be rather difficult to completely ascertain the cost savings EHRs have until they are more widely adopted by physicians. We are only beginning to see the critical mass on EHRs and have yet to see the same numbers of the connectivity between systems that will probably ultimately end up saving the money. One only has to look at Kaiser to see how good EHRs and Patient Portals are for business.Jay SimmonsInformation Week Contributor

"The original research paper they refer to was published online October 7, 2011, not exactly what I'd call new. " Not a good defense, considering the amount of time it takes to conduct these research projects.

Also, whenever the federal goverment starts making new requirements, the subjects of the new requirements expect the federal government to pick up the tab. Being able to copy/paste for new payments could be gaming the system. It could also have the unintended consequence of making the doctors lazier in their documentation.

There are lots of issues with EHR, even without speaking to privacy/hacking concerns. There needs to be much more research conducted before we force our healthcare providers into this system.

As InformationWeek Government readers were busy firming up their fiscal year 2015 budgets, we asked them to rate more than 30 IT initiatives in terms of importance and current leadership focus. No surprise, among more than 30 options, security is No. 1. After that, things get less predictable.